Provider Demographics
NPI:1376599662
Name:NAKAMOTO, LAVONDA (MD)
Entity Type:Individual
Prefix:DR
First Name:LAVONDA
Middle Name:
Last Name:NAKAMOTO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LAVONDA
Other - Middle Name:
Other - Last Name:MEE-LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:459 PATTERSON RD
Mailing Address - Street 2:CFA
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819-1522
Mailing Address - Country:US
Mailing Address - Phone:808-433-0224
Mailing Address - Fax:808-433-0281
Practice Address - Street 1:459 PATTERSON RD
Practice Address - Street 2:CFA
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-1522
Practice Address - Country:US
Practice Address - Phone:808-433-0224
Practice Address - Fax:808-433-0281
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD12941174400000X
HI12941207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI554817-02Medicaid
HI554817-01Medicaid
HI57166Medicare ID - Type Unspecified